The Origins of Adaptive Design

So, sort of the origins of those ideas about adaptive designs, it goes back and people have used it in the clinical trial models. In clinical trials there are... usually, it's broken down into Phase I, Phase II, and Phase III clinical trials and what we are comfortable and recognize, usually in Phase III, is the standard clinical trial that we really understand. But there is a lot of work that's done beforehand in the clinical trial phase in here of trying to understand what the potential effectiveness of an intervention is, the safety of it as well.

People have started to work on how can you shorten the time it takes for doing a systematic work on an intervention? What they found is that in the clinical trials literature if you start to take Phase 2 trials and Phase 3 trials and merge those together you get something that is shortened in time. The same things could be used in behavioral interventions or very complex interventions that we're trying to look at that affect drug use, for example, or depression.

What we're finding is if you just go through the standard sets of projects in here and do each of these projects separately, it's going to take you 20 years to get to the end of this whole set and we don't have that time. So the question is can you shorten that period of time? Now, what we talk about often is effectiveness studies and then follow them up with implementation studies afterwards.

But one of the questions is could you integrate those together in the same kinds of study? What we've found is several different ways of technically doing that, where you start with an effectiveness question and then you move into the next cohort of children, for example, and do an implementation study at the same time and see whether the same teachers are able to sustain that kind of intervention with the same kind of precision that they had in the first attempt that they had with the first cohort. So, what this is doing is pulling together and shortening the amount of time it takes for conducting a set of research to move to scale and deliver these in communities.